Highlights
- •Less than 70% refilled their medications at least 80% of the time over 2 years.
- •Missed appointments, mood disorders, and traumatic brain injuries are among the risk factors.
- •There is an urgent need for interventions aimed at person-level barriers.
- •Disease-modifying therapy adherence should be discussed at every visit, whether it is multiple sclerosis–related or not.
Abstract
Objective
To determine which factors are associated with suboptimal disease-modifying therapy
(DMT) adherence and to develop an explanatory model that could be used to identify
individuals at risk and potentially inform interventions.
Design
Cross-sectional cohort study using electronic health records.
Setting
Veterans Health Administration (VA).
Participants
Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through
the VA and were included in the VA MS Center of Excellence Data Repository.
Interventions
Not applicable.
Main Outcome Measures
Suboptimal DMT adherence (<80%), demographics, co-occurring conditions, and health
care use.
Results
Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence
included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic
brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47;
95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67),
mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66),
and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95%
CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated
with lower risk.
Conclusions
Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on
person-level barriers should be urgently explored to increase adherence and improve
self-management abilities.
Keywords
List of abbreviations:
DMT (disease-modifying therapy), EHR (electronic health record), ED (emergency department), ICD (International Statistical Classification of Diseases and Related Health Problems), MS (multiple sclerosis), OR (odds ratio), TBI (traumatic brain injury), VA (Veterans Health Administration)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 03, 2019
Footnotes
The views and opinions expressed in this article reflect those of the authors and do not necessarily reflect those of the United States Department of Veterans Affairs.
Supported in part by the Bell-Kerns Award from VA Connecticut Healthcare System and the VA MS Centers of Excellence.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
